Provider Demographics
NPI:1255464558
Name:STEPHENS, BONNIE NELSON (BS)
Entity Type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:NELSON
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3394 LAS HUERTAS RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-5156
Mailing Address - Country:US
Mailing Address - Phone:925-933-0105
Mailing Address - Fax:
Practice Address - Street 1:3182 OLD TUNNEL RD STE B
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-4152
Practice Address - Country:US
Practice Address - Phone:925-933-0105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist